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02598
CERTIFICATE O ONSTRI
Located at
Owner r `� M'y��1
WER EMUS r
PUTNAM COUNTY DEPARTMENT OF HEALTH PROVIDE
Division of frivironmental,HwIth Services, Cann% &,,-Y. 10592 PERMIt #, � V 31 5G
CTION COMPLIANCE FOR SEWAGE-DISPOSAL SYSTEM P071,/Ad , LLEJ
Town or Village
Tax ,Kap ,Block
lrr `� r Formerly k1�U --o �5!CA"frS �NT Map Lot n Subd. Lot H
Separate Sewerage System built by '6" . - —
Consisting of i yy7 Gal. Septic Tank and
Other requirements
Water Supply: Public Supply From 1.
Private Supply Drilled By
Address -
Building Type FAI411 4 No. of Bedrooms Date Permit Issued � 3o SIo
Has Erosion Control Been- Completed? garbage grinder been installed?
I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies
of which are attached), and in accordance with the 'standards, rules and regulations, in accordance with'the filed plan, and the permit issued by the
Putnam County Department Of Health. •,
Date
P.E. X R.A.
License No. Q , 06 v
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shalt become null and void as soon as a public sanitary sewer becomes
available and the approval of the:,private water supply shall become null and void whop a public water supply becomes available. Such approvals are
subject t modification or change when, in the' Judgment of the Commissioner of Health, such revocation, modification or change is necessary.
r _
Date By Title
Rev. 6/85'
.'D
PU NAM COURN DEPARTMENT OF HEALTH
- _ DIVISION- OF_:ENVIRONMENrAL.- HEALTH... SERVICES -.- - - -
NI L CA-w, l)av4 LoPicA,,Ir e°
Owner or Purchaser of Building
t
Building Constructed by
Location - Street
Municipality n� t
i'a'�tn-.�C.c.
Building Type
3
Section Block Lot
WICap�� �Stcs e.S
Subdivision Name
3
Subdivision Lot #
GUARANM OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it has been constructed as shown on
the. approved plan or approved amendment thereto, and in accordance with the
standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or'assigns, to place in good
operating.condition any part of.said system constructed by me which fails to
operate for a period of two years immediately following the date of approval of the
Certificate -of Construction Compliance" for the = sewage - disposal _syst=M, or
repairs made by me to such system, except where the failure to operate proper, y is
caused by the willful or negligent act of the occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environmental Health Services of- the Putnam County
Department of Health as to .wherher or not tide iaiiure of Uie 5ysLen % o operace eras
caused by the willful or negligent act of the occupant of the building utilizing
the system.
Dated this y of 19 F 2�
kJ4 F-A-P, OE- vEZ :v` -
General Contractor er)`- Signature
Corporation Name (if Corp.)
Address E L lhty Fu'Z -D � y l a y ' 3
rev. 9/85
mk
Signatur .a--,
Title �,.,�,
Corporation Name (if Corp.)
`1 AJo
Address
,��Lo-s FvA-o? by Ms--1-3
i•
a P4
* r
. _._ ._ _
WLLL U%Jr1rLG11Vly nr,rVni
DEPARTMENT OF HEALTH
..._ �i,; �, is- i,�n•�0£_.Er_- v.irr,.nmental,. Health :RSer�ri��s.�:._�,�;.;,_,:
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
- - - -
WELL LOCATION
j
WELL OWNER
STREET AOURESS. ToWNIVIELALAIC11Y TAX GRID NUMBER:
11,,P j
N �tE: AOOR Ss: PRIVATE
A,5�- C-Zm rd ❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
KRESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND.IHEAT PUM ❑ ABANDONED
0 BUSINESS O FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
'J4 NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
O REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH ft. I
STATIC WATER LEVEL / _l!j ft.
DATE MEASURER, 4A7
DRILLING
EQUIPMENT
❑ ROTARY ;KCOMPRESSED AIR PERCUSSION ❑ DUG
❑WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK O OTHER
TOTAL LENGTH 41 ft.
MATERIALS: ASTEEL ❑ PLASTIC 0 OTHER
CASING
DETAILS
LENGTH.BELOW GRADE ft.
JOINTS: 0 WELDED ' THREADED 0 OTHER
DIAMETER in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITE THER
WEIGHT PER FOOT
lb./ft.
DRIVE SHOE: 0 YES . NO
I LINER: O YES 0 NO
SCREEN
-- F T AILS- _ _
DIAMETER (in)
'SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
_
❑YES -ONO
HOURS
SECOND
GRAVEL PACK
O YES
❑ NO
GRAVEL
SIZE
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TEST If detailed pumping
I P P 9
METHdo: O PUMPED it tests were done is in-
COMPRESSED AIR , formation attached?
BAILED ❑ OTHER ; 0 YES 0 NO
WELL LOG if more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
my
Well
Dia-
In
FORMATION OESCRIPTION
CODE.
ft.
ft
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
R,
YIELD
gCm.
Land Surface
,
r
WATER ACLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? &YES ONO
9
STORAGE TANK: TYPE;�@y`�f�jL,
CAPACITY GAL.
PUM HFORMATION
I
TYPE �•% m Pf`S'th 1 CAPACITY
MAKER �� 9 S DEPTH
MODEL �_L___- VOLTAGE�H -
W NAM�j qq
t LtSin. 61
SIG r R _
1
LAB # Mk„ 002811
Ydrkt6w iNedical :Laboratory, Inca =--- - - = -_�
321 KearScreec Collection Station Used:
wn Heights, N. Y. 10598 Carmel Peekskill
Yorktown - z caper c„>
Director: Albert H. Padovani M. T. (ASCP) Date Taken : J./
T- Date Received: 3/'.3/ "? ;� c
Date Reported: -.
Collected By: 7ez
Referred By.:
Sample Source: o
L
LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER
GENERAL BACTERIA
X-
Standard P1ate,Count per 1.O ml Z
(Agar.plate @ 35 0C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
Total Coliform ner 100 ml.
Fecal, Coliform ner 100 ml
Fecal Streptococcus per 1.00 ml
"OST PROBABLE NUMBER TECHNIO.UF; (.MPN )
Total Coliform: MPN Index ner 100 ml
'Fecal Coliform: b`.1N Index .per 100 ml
OTHER ANALYSES
THESE RESULTS INDICATE THAT THE WATER SAMPLE
OF A SATISFACTORY SANITARY QUALITY ACCORDING
WATER.STAND.A.RDS, FOR THE PARAMETERS TESTED, AT
Albert H. Padovani, ?�.T. (ASCP), Director
}(WAS NOT) (NOT APPLICABLE),
/NEW YORK STATE DRINKING
TIME OF COLLECTION.
LEGEND
RDS = Recommend Disinfect -
ing Water Source
< = less than
TNTC = Too Numerous Too
Count
711 71_777
I?ev,, 3186 Division of Environmental Health Services.. _Qzmel, N. V
permit #
CONSTRU[C TI nN P 3' DISPOSAL SYSTEM,
Putnai
',-,Town or Nithwe
-0scalArapa e
Tax Aftio —3.3
Subdivision Name
� 0 Revision �
Date of P6A'ous Approval
_ftmfor.d'! '10513
Mailing Address .44 North Central Avehue � .
Building Type fami.. re i dence Lot Area�, 5-1-35 t [iF�Mjactio- Only Depth —Vo . In*
on Fill ted
Numb of Bedrooms 4 —Design Flow G/P/b 800 'GPD 711101 Notificad is Required When Is �omvle
er
on Sieptl. Tank and-
�
'__- Supply: ---_,r` Frorn Address
Adren
or: x ate. Supply Drilled Oy
Other Requirements
I represent t I hat I' wholly and: coni-piete'ly responsible:for. t"ha,design and I ocation of'.the proposed system(s)..J) that the separate sewage d
above described will be constructed a there to and in accordance With -the standards. rules nscifm Toe IAM
C unty sit'sfactory'tiY the commissioner of Health will
o Department of, H.alth, and that on completion iherioia-Certificate of Construction Com`piianc I
_ submitted _-
place in good operating condition any part of said iiwa4e, ciisposai system during. the peii0d of tvii�c! (2) years imrriediately following thedate of the issu
ance of the approval of the C I ertificate of Cons I tructiori4"C-omplianice of -the'original s s tam or any'ripairi fhereto; 2) that the drilled well described above
will be located as shown on.the d' "=, ^ app��~* = rules and regurallonsof. th46 Putnam
County Department of Health.
Date 7_2 ida"A4 signed
37. Fai
Address Qqshin Assoc C, t, S;C./CqMe1,N.t —License No 26008--
APPROVED FqR CONSTRUCTION: 'This approval experespnei year'fronAt6a data issu o unless' c a building has been undertaken and is
revocable for fese Wrkn be amer cled or modified when coMidert, 6' 'ry
�
` Date Title
_ ,_--- -''--'—.--- ------'_-__-~_-_--_°-~��~- .7-'-___'._--__---_�_---_�^
y
PUTNAM COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS
y DATE: I- .I....I
i o c e- � � -� C-,:- 1-,f C � � i '� � � I� INSP. BY:
(Nine of Owner) (Street Location)
INITIAL SITE INSPECTION YES1 N01 COMMENTS
Wetlands on /or proximate to property ..............
Property lines or corners found ...................
Can estimate house location .......................
Willdriveway need cut ............................
Must trees be rived - note these ................
Deep holes representative of entire SDS area., .....
Additional -deep holes needed..... . ....
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells /septics ............................
D.H. -Deep Hole
G.W. - Groundwater
D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot
Depth to G. W. Depth to G. W. Depth to G.W.
Depth to rock Depth to rock Depth to rock
Soil uescri
0 ft.
3 ft.
6 ft.
9 ft.
.on Soil
0 ft.
3 ft.
6 ft.
9 ft.
Soil Descri tia
0 ft.
3 ft.
6 ft.
9 ft.
DATE:
FINAL SITE INSPECTION INSP.BY: Y
YES N
NO C
COMMENTS
House SSDS located per approved plan. ..b....... C
C_5 I � ivan ha 1K
Slope of tile line and trench acceptable......... X
X
<X
Room allowed for expansion trenches .............. <
Over 100 ft. from watercourse ....................
Natural soil not stripped or SDS area
unnecessarly graded ............. ... ........
10 ft. maintained from property line and
20 ft. from house ..............................
+.l
Distance well to SSDS (ft.) ...................... +
X,
Number of bedrooms checks ........................ X
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench.. ...........
� I
I_
15 ft. of peripheral soil horizontally �
Boxes properly set ...............................
k h
h 2 C � in M 0S
Could surface runoff from driveway, roads, k
it
Putnam County Department of Health
Division or Environmental Sanitation
AFFIDAVIT -- CORPORATE (XINER APPLTCATTON
FOR PERMIT APPLICATION SUBMTTTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of HeEtlth - In the matter of application for
ES-rATE�'
— — — — — —
- -- — — — — ---=-------------
I,
— — — — — — — — — — — — — — — — — - — — ,represent
that I am an officer or employee of the corporation and am authorized
to act for I /►�
7 — — — — — — — — — - - — — — 1 7 - — — — — — — — — — —
(name of corporation)— —
having offices at -44 O&P—T AY'
— ----- — _ -- -- — — — — — — — — — — — — — — — — — Whose officers are
President
11 — — —
(Name and Address) — — — — — — —
es) —
Vice-President -- — — — — — —
(Name and Address)
Secretary
(Name and Address)
Treasurer
" (Name and Address)
and that I am and will be individually responsible for any or all acts
of the corporation with respect to the approval. requeste a d all sub-
'equent"acts , r ing thereto ;d
sequent:,qcts!;r.pl_ ing,.thereto.
_,e
0
w e - �1—_— --,
rn 0 efope thi
Sworn to thi
day Signeq---. — — — — — — — — — --
of
19 Title
C4= _L — ----- - - - - --
N
VG a
o
Corporate Seal
PUTNAM .._,JUNTY DEPARTMENT OF HEALTH �--"
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING _.,Y.CARMEL,
.—STGN DATA SHEET- SEPARATE,
SEWAGE DTSPOSAL SYSTEM FILE NO. :.
ciwner'_ 1 rO TES It�aG.. tiddre•sr l �� � . -ri� A%/ .
C ' LQI�,: PJ Y
W �cc� PEcz GT. _� _
.� :.. - taS2;
Located at ( Street 0&CAWArr A- I +hs- Ro. Sec . 35" Block
�Indicate
nearest cross street)
?anicipa lit y PUTMAM yALL.L
y' Watershed_ C.RO"i'y (V
SOIL PERCOLATION TEST
DATA RE-QUIRFD. TO BE SUBMITTED. WIN --.,A
3 2-So - 2- 3c1
__:umE.)er• CLOCK TIME
PERCOLATION _.PERCOLATION
I ?uri lapse
ep i to • a er Water ve
tdc�• Time
From Ground' Surface in Inches.. -'Soil Rate
Start -Stop Min.
Start Stop Drop in Ain./in drop
Tnches Inches Inches
-- '2.22 -23I
_ 2-3 ►
��.2,21 _ 2- Zy
3 2-So - 2- 3c1
5 - -- - -
Notes: 1) Tests to be repeated at same depth until e�ppproximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for, review.
2) Depth measurements to be made from top of hole.
e
TEST PIT DATA REQUIRED TO BE SUBMITTIM WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO HOLE NO.
G.L.
6u
181
`4 n
42" ,
511
60"
66"
72
78..
84"
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED.''.
INDICATE LEVEL TO WHICH WATER LEVEL RISES. AF-TER... BEING ENCOUN
TES'T'S /�: _ .. _ _ r .._ ..... _ �. �. - Date
....._ .._.. _ MADE �BY_- _ � �.� Y<
DESIQN
Soil Rate Used0 -6- Min/1 "Drop: S.D. Usable Area j,--
No. of Bedrooms 3" Septic Tank Capacity' a
Absorption Area Provided By -2!Q L. F. x24" �5s "''= wditrpnc .
Other
Address 3;7
F��R S� SEA - nj4: rI
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq.' Ft; /Cal. Checked by 17ate
PUINAM OOLWN • DEPARnIERr OF HEALTH
`DIVISION OF IWIROIMENTAL HEALTH SERVICES
Date'... -7 -, /rz�& .. . ,
Re: Property of lXJE'C�> , , "14C,
Located at
(T) Oki�A V A LLE"Section S Block ' lot ' -2"
Subdivision oflc.
_Z � � `t Ofd tcc- l3 100
5ubdv. L'ot. �� � Field Map �� Date �
Gentlemen'-.
This letter is to authorize C
a duly-licensed Professional Engineer or.Re iz istered Architect to
ICATE- ,K;
apply- for a.Constsuctibn.Permit f6r a separate sewage system, to serve the above noted
property in accordance-with the standards, rules or .regulations as promulgated by the
Coamissioner of the Putnam County.Department of Helath, and to sign all -necessa-sy papers
an my behalf in connection with this matter and to supervise the .constructioa of said
system or systems in conformity with the provisions of Article 145 or 147, Education Law,
the- Public Health Law, and the Putnam meaty 'Saiiitary Code.
Countersigne
37 t'AtP_ 'CAP_ jA_(C- L.
ess
22s-�
Te ep
.0
Very. truly. yours ,
SIED -A
GN ' l % ✓.�
of roperty
Address
y
CASHIN ASSOCIATES, P.C.
_ HUDSON VALLEY DIVISION
Architects o Engineers a Surveyors
37 Fair Street, Carmel, New York 10512
(914) 225 -8088 CABLE: CASHASSOC MINEOLANEWYORKSTATE
MAY 29,1986
Mr. Jack Karrell
Putnam County Department of Health
County Office Building
Carmel, New York 10512
Dear Mr. Karrell:
Please find enclosed four (4) copies of Wiccopee Estates (II)
Lot #5 and (I) Lot #3 with revisions as per your telephone
call on May 27, 1986. Also enclosed are Authorization Forms
and New Construction Permits for both Lots.
Very truly yours,
CASHIN ASSOCIATES, P.C.
By A�JA a/ I -
G'ary A. Tretsch
GAT /g j 1
Enclosures
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